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Culturally adapting a physical activity intervention for Somali women: the need for theory and innovation to promote equity

  • Original Research
  • Published:
Translational Behavioral Medicine

Abstract

There is pressing need for innovation in clinical research to more effectively recruit, engage, retain, and promote health among diverse populations overburdened by health disparities. The purpose of this study is to provide a detailed illustration of the cultural adaptation of an evidence-based intervention to bolster translational research with currently underserved communities. The cultural adaptation heuristic framework described by Barrera and colleagues is applied to the adaptation of a physical activity evidence-based intervention with adult Somali women. Widespread changes were required to ensure program feasibility and acceptability, including the reduction of assessment protocols and changes discordant with current trends in physical activity research. The cultural adaptation of evidence-based interventions offers an important mechanism for reducing health disparities. Improved reporting standards, assessment of features relevant to underserved communities, and greater funding requirements to ensure better representation are needed to promote more widespread access for all people.

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References

  1. de las Nueces D, Hacker K, DiGirolamo A, Hicks LS. A systematic review of community-based participatory research to enhance clinical trials in racial and ethnic minority groups. Health Services Research. 2012; 47: 1363-1386.

    Article  PubMed  Google Scholar 

  2. Hussain-Gambles M, Atkin K, Leese B. Why ethnic minority groups are under-represented in clinical trials: a review of the literature. Health & Social Care in the Community. 2004; 12: 382-388.

    Article  Google Scholar 

  3. Wallerstein N, Duran B. Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity. American Journal of Public Health. 2010; 100: S40-S46.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Nelson AR, Smedley BD, Stith AY, eds. Unequal treatment: confronting racial and ethnic disparities in health care, vol. 1. Washington, DC: National Academies Press; 2009.

    Google Scholar 

  5. Kwiatkowski K, Coe K, Bailar JC, Swanson GM. Inclusion of minorities and women in cancer clinical trials, a decade later: have we improved? Cancer. 2013; 119: 2956-2963.

    Article  PubMed  Google Scholar 

  6. Barrera M Jr, Castro FG, Strycker LA, Toobert DJ. Cultural adaptations of behavioral health interventions: a progress report. Journal of Consulting and Clinical Psychology. 2013; 81: 196-205.

    Article  PubMed  Google Scholar 

  7. Castro FG, Barrera M Jr, Holleran Steiker LK. Issues and challenges in the design of culturally adapted evidence-based interventions. Annual Review of Clinical Psychology. 2010; 6: 213-239.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ko LK, Reuland D, Jolles M, Clay R, Pignone M. Cultural and linguistic adaptation of a multimedia colorectoral cancer screening decision aid for Spanish-speaking Latinos. Journal of Health Communication. 2014; 19: 192-209.

    Article  PubMed  Google Scholar 

  9. Resnicow K, Baranowski T, Ahluwalia JS, Braithwaite RL. Cultural sensitivity in public health: defined and demystified. Ethnicity & Disease. 1998; 9: 10-21.

    Google Scholar 

  10. Barrera M Jr, Castro FG. A heuristic framework for the cultural adaptation of interventions. Clinical Psychology: Science and Practice. 2006; 13: 311-316.

    Google Scholar 

  11. Castro FG, Barrera M Jr, Martinez CR. The cultural adaptation of prevention interventions: resolving tensions between fidelity and fit. Prevention Science. 2004; 5: 41-45.

    Article  PubMed  Google Scholar 

  12. Venters H, Gany F. African immigrant health. Journal of Immigrant and Minority Health. 2011; 13: 333-344.

    Article  PubMed  Google Scholar 

  13. Murray K, Mohamed AS, Dawson DB, Syme M, Abdi S, Barnack-Tavlaris J. Somali women’s perspectives on physical activity: Photovoice to initiate community change. Progress in Community Health Partnerships. 2015; 9: 83-90.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Murray KE, Mohamed AS, Ndunduyenge GG. Health and prevention among east African women in the US. Journal of Health Care for the Poor and Underserved. 2013; 24: 233-246.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Guerin PB, Elmi FH, Corrigan C. Body composition and cardiorespiratory fitness among refugee Somali women living in New Zealand. Journal of Immigrant and Minority Health. 2007; 9: 191-196.

    Article  PubMed  Google Scholar 

  16. Renzaho AM, Nowson C, Kaur A, Halliday JA, Fong D, Desilva J. Prevalence of vitamin D insufficiency and risk factors for type 2 diabetes and cardiovascular disease among African migrant and refugee adults in Melbourne: a pilot study. Asia Pacific Journal of Clinical Nutrition. 2011; 20: 397-403.

    CAS  PubMed  Google Scholar 

  17. Marcus, B. H., Napolitano, M. A., King, A. C., Lewis, B. A., Whiteley, J. A., Albrecht, A. E., … & Jakicic, J. M. (2007). Examination of print and telephone channels for physical activity promotion: rationale, design, and baseline data from project STRIDE. Contemporary Clinical Trials, 28, 90–104.

  18. Marcus, B. H., Napolitano, M. A., King, A. C., Lewis, B. A., Whiteley, J. A., Albrecht, A., … & Jakicic, J. (2007). Telephone versus print delivery of an individualized motivationally-tailored physical activity intervention: project STRIDE. Health Psychology, 26, 401–409.

  19. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology. 1983; 51(3): 390-395.

    Article  CAS  PubMed  Google Scholar 

  20. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs NJ: Prentice-Hall; 1986.

    Google Scholar 

  21. Pekmezi, D. W., Neighbors, C. J., Lee, C. S., Gans, K. M., Bock, B. C., Morrow, K. M., … & Marcus, B. H. (2009). A culturally adapted physical activity intervention for Latinas: a randomized controlled trial. American Journal of Preventive Medicine, 37, 495–500.

  22. Pekmezi, D., Marcus, B., Meneses, K., Baskin, M. L., Ard, J. D., Martin, M. Y., … & Demark-Wahnefried, W. (2013). Developing a theory-based intervention to address physical activity barriers for African American women in the deep south. Women and Health, 9, 301–312.

  23. Marcus, B. H., Dunsiger, S. I., Pekmezi, D. W., Larsen, B. A., Bock, B. C., Gans, K. M., … & Tilkemeier, P. (2013). The Seamos Saludables study: a randomized controlled physical activity trial of Latinas. American Journal of Preventive Medicine, 45, 598–605.

  24. Larsen, B.A., Dunsiger, S., Hartman, S., Nodora, J., Pekmezi, D.W., … & Marcus, B.H. (2014). Activo: assessing the feasibility of designing and implementing a physical activity intervention for Latino men. International Journal of Mental Health Nursing, 13, 60–71.

  25. Hannon PA, Bowen DJ, Christensen CL, Kuniyuki A. Disseminating a successful dietary intervention to faith communities: feasibility of using staff contact and encouragement to increase uptake. Journal of Nutrition Education and Behavior. 2008; 40: 175-180.

    Article  PubMed  Google Scholar 

  26. Guerin PB, Diiriye RO, Corrigan C, Guerin B. Physical activity programs for refugee Somali women: working out in a new country. Women and Health. 2003; 38: 83-99.

    Article  PubMed  Google Scholar 

  27. Arcan C, Larson N, Bauer K, Berge J, Story M, Neumark-Sztainer D. Dietary and weightrelated behaviors and body mass index among Hispanic, Hmong, Somali, and white adolescents. Journal of the Academy of Nutrition and Dietetics. 2014; 114: 375-383.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Burns C. Effect of migration on food habits of Somali women living as refugees in Australia. Ecology of Food and Nutrition. 2004; 43: 213-229.

    Article  Google Scholar 

  29. Wilson A, Renzaho A. Intergenerational differences in acculturation experiences, food beliefs and perceived health risks among refugees from the horn of Africa in Melbourne. Australia Public Health Nutrition. 2015; 18: 176-188.

    Article  PubMed  Google Scholar 

  30. Devlin JT, Dhalac D, Suldan AA, Jacobs A, Guled K, Bankole KA. Determinants of physical activity among Somali women living in Maine. Journal of Immigrant and Minority Health. 2012; 14: 300-306.

    Article  PubMed  Google Scholar 

  31. Gardner K, Salah S, Leavey C, Porcellato L. The perfect size. Perceptions of and influences on body image and body size in young Somali women living in Liverpool-a qualitative study. Diversity & Equality in Health and Care. 2010; 7: 23-24.

    Google Scholar 

  32. Marinescu LG, Sharify D, Krieger J, Saelens BE, Calleja J, Aden A. Be active together: supporting physical activity in public housing communities through women-only programs. Progress in Community Health Partnerships. 2013; 7: 57-66.

    Article  PubMed  Google Scholar 

  33. Rothe E, Holt C, Kuhn C, et al. Barriers to outdoor physical activity in wintertime among Somali youth. Journal of Immigrant and Minority Health. 2010; 12: 726-736.

    Article  PubMed  Google Scholar 

  34. Wieland ML, Weis JA, Palmer T, et al. Physical activity and nutrition among immigrant and refugee women: a community-based participatory research approach. Womens Health Issues. 2012; 22: e225-e232.

    Article  PubMed  Google Scholar 

  35. Minkler M, Wallerstein N, eds. Community-based participatory research for health: from process to outcomes. San Francisco: Wiley; 2010: 2010.

    Google Scholar 

  36. Lopez EDS, Eng E, Robinson N, Wang CC. Photovoice as a community-based participatory research method: a case study with African American breast cancer survivors in rural eastern North Carolina. In: Israel BA, Eng E, Schulz AJ, Parker EA, eds. Methods for conducting community-based participatory research for health. San Francisco: Jossey-Bass; 2005: 326-348.

    Google Scholar 

  37. Kreuter MW, Wray RJ. Tailored and targeted health communication: strategies for enhancing information relevance. American Journal of Health Behavior. 2003; 27: S227-S232.

    Article  PubMed  Google Scholar 

  38. Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. Journal of Clinical Epidemiology. 1993; 46: 1417-1432.

    Article  CAS  PubMed  Google Scholar 

  39. Berkman ND, DeWalt DA, Pignone MP, et al. Literacy and health outcomes. (AHRQ publication no. 04-E007–2). Rockville: Agency for Healthcare Research & Quality; 2004.

    Google Scholar 

  40. Geltman PL, Adams JH, Penrose KL, Cochran J, et al. Health literacy, acculturation, and the use of preventive oral health care by Somali refugees living in Massachusetts. Journal of Immigrant and Minority Health. 2013; 16: 622-630.

    Article  Google Scholar 

  41. Wilson LD. Developing low-literacy health education materials for women. MCN: American Journal of Maternal Child Nursing. 2011; 36: 246-251.

    PubMed  Google Scholar 

  42. Plimpton S, Root J. Materials and strategies that work in low literacy health communication. Public Health Reports. 1996; 109: 86-92.

    Google Scholar 

  43. Geisinger KF. Cross-cultural normative assessment: translation and adaptation issues influencing the normative interpretation of assessment instruments. Psychological Assessment. 1994; 6: 304.

    Article  Google Scholar 

  44. Willis GB. Cognitive interviewing: a tool for improving questionnaire design. Thousand Oaks: Sage; 2005.

    Book  Google Scholar 

  45. Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 4th ed. Thousand Oaks: Sage Publications, Inc.; 2009.

    Google Scholar 

  46. Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health. Family Medicine. 2004; 36: 588-594.

    PubMed  Google Scholar 

  47. Zea MC, Asner-Self KK, Birman D, Buki LP. The abbreviated multidimentional acculturation scale: empirical validation with two Latino/Latina samples. Cultural Diversity & Ethnic Minority Psychology. 2003; 9: 107-126.

    Article  Google Scholar 

  48. Tolaymat L, Moradi B. U.S. Muslim women and body image: links among objectification theory constructs and the hijab. Journal of Counseling Psychology. 2011; 58: 383-392.

    Article  PubMed  Google Scholar 

  49. Hussain A, Bjorge B, Hjellset VT, Holmboe-Ottesen G, Wandel M. Body size perceptions among Pakistani women in Norway participating in a controlled trial to prevent deterioration of glucose tolerance. Ethnicity and Health. 2010; 15: 237-251.

    Article  PubMed  Google Scholar 

  50. Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J. Indochinese versions of the Hopkins symptom checklist-25: a screening instrument for the psychiatric care of refugees. The American Journal of Psychiatry. 1987; 144: 497-500.

    Article  CAS  PubMed  Google Scholar 

  51. Chang WE, Brown R, Nitzke S. Participant recruitment and retention in a pilot program to prevent weight gain in low-income overweight and obese mothers. BMC Public Health. 2009; 9: 424.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Coatsworth JD, Duncan LG, Pantin H, Szapocznik J. Patterns of retention in a preventive intervention with ethnic minority families. Journal of Primary Prevention. 2006; 27(2): 171-193.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

This project was supported in part by MRSG-13-069-01-CPPB from the American Cancer Society and by the National Institutes of Health (NIH) grant UL1TR000100. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or ACS. We would also like to thank Drs. Alan Shahtaji and Amy Leu for their support of the project.

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Authors and Affiliations

  1. Department of Family Medicine & Public Health, UC San Diego, San Diego, CA, USA

    Kate E. Murray PhD, MPH, Sarah Linke PhD, MPH, Jacqueline Kerr PhD & Bess H. Marcus PhD

  2. School of Psychology and Counselling, Queensland University of Technology, QUT-Kelvin Grove Campus, GPO, Box 2434, Brisbane, Queensland, 4001, Australia

    Kate E. Murray PhD, MPH

  3. The Health Management Academy, Alexandria, VA, USA

    Azieb Ermias MPH

  4. Clinton Health Access Initiative, Boston, MA, USA

    Amber Lung MPH

  5. Department of Pediatrics, UC San Diego, San Diego, CA, USA

    Amina Sheik Mohamed MPH

  6. Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    B. Heidi Ellis PhD

  7. School of Public Health, University of Washington, Seattle, WA, USA

    Deborah J. Bowen PhD

Authors
  1. Kate E. Murray PhD, MPH
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  2. Azieb Ermias MPH
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  3. Amber Lung MPH
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  4. Amina Sheik Mohamed MPH
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  5. B. Heidi Ellis PhD
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  6. Sarah Linke PhD, MPH
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  7. Jacqueline Kerr PhD
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  8. Deborah J. Bowen PhD
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  9. Bess H. Marcus PhD
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Corresponding author

Correspondence to Kate E. Murray PhD, MPH.

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Originality

The findings reported have not been previously published and are not under review at any other publication. There are no prior publications from this dataset. The authors have full control of all primary data and the data will be made available for review if requested by the journal.

Human and animal rights and informed consent

All aspects of the research were approved by the Institutional Review Board of the sponsoring institution prior to the initiation of research. All participants provided informed consent, and the research followed ethical principles outlined by international research ethics standards (e.g., Declaration of Helsinki, Belmont Report) that maintain the human rights of participants and their autonomy, wellbeing, and benefit from participating in research. Animals were not involved in the current research; therefore animal welfare standards do not apply.

Additional information

Implications:

Research: Cultural adaptation models should guide translational research aimed at reaching diverse, underserved populations, with reporting standards raised for documenting the cultural adaptation processes implemented.

Practice: Physical activity programs for migrant and refugee communities benefit from community-engaged approaches to ensure cultural factors, such as unique barriers and opportunities to being active, are considered in programs to maximize effect.

Policy: Funding agencies should support broader efforts to ensure underrepresented groups in clinical trials and public health programs have access to and benefit from evidence-based programs.

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Murray, K.E., Ermias, A., Lung, A. et al. Culturally adapting a physical activity intervention for Somali women: the need for theory and innovation to promote equity. Behav. Med. Pract. Policy Res. 7, 6–15 (2017). https://doi.org/10.1007/s13142-016-0436-2

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  • DOI: https://doi.org/10.1007/s13142-016-0436-2

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